Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers.

Autor:	Tettelbach WH; HCA Healthcare, Mountain Division, US.; College of Podiatric Medicine, Western University of Health Sciences, US.; Duke University School of Medicine, Department of Anesthesiology, US.; Association for the Advancement of Wound Care, US.; American Professional Wound Care Association, US.; MiMedx Group Inc., GA, US., Driver V; Wound Care and Hyperbaric Centers at INOVA Healthcare, US.; Wound Care Collaborative Community, US., Oropallo A; Comprehensive Wound Healing Center, US.; Hyperbarics at Northwell Health, US., Kelso MR; Wound Care Plus, LLC, MO, US., Niezgoda JA; AZH Wound & Vascular Centers, US., Wahab N; Wound Care Experts, NV, US.; HCA Mountain View Hospital, US.; Roseman University College of Medicine, US.; Common Spirit Dignity Hospitals, US., De Jong JL; MiMedx Group Inc., GA, US., Hubbs B; MiMedx Group Inc., GA, US., Forsyth RA; MiMedx Group Inc., GA, US.; Department of Biology, San Diego State University, US., Magee GA; Keck School of Medicine, University of Southern California, US.
Jazyk:	angličtina
Zdroj:	Journal of wound care [J Wound Care] 2023 Nov 02; Vol. 32 (11), pp. 704-718.
DOI:	10.12968/jowc.2023.32.11.704
Abstrakt:	Objective: To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs). Method: Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups. Results: In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use). Conclusion: Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation. Competing Interests: Declaration of interest: This study was supported by MIMEDX Group Inc., US. JLD and RAF are employees of MIMEDX Group Inc. WHT and BH are consultants to MIMEDX Group Inc. VD, AO, MRK, JAN, NW and GM served on the Advisory Board of MIMEDX Group Inc.
Databáze:	MEDLINE
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